dual diagnosis - iep day powerpt (1 1)

8/14/2019 Dual diagnosis - IEP Day Powerpt (1 1)

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Dual diagnosis:

When there is apsychiatric disorder

on top of a

IEP Day April 11, 2008

Joshua D. Feder, MD

Faculty, Interdisciplinary Council on Developmental and LearningDisorders

Assistant Clinical Professor, Department of Psychiatry,


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There are no clean

patients in

Dual Diagnosis in education =

Intellectual Disability + MH disorder Dual Diagnosis in Mental Health =

Psychiatric + Substance Problem

Lumpers: It is all TS, or It is allAutism

Splitters: The person qualifies formulti le dia noses


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Practicalities:

List and prioritize target symptoms

Find the lynchpins e.g. alcohol,

inattention, depression its differentfor each individual


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What are the diagnoses?

And Depression

And Substance Abuse

And OCD

And Psychosis


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SOAPED Mnemonic:

Substance drugs, medicines, poisons,supplements, etc.

Organic brain trauma, seizures, tuberous

sclerosis, etc. Affective/anxiety/abuse includes bipolar,depression, OCD, simple phobias, PTSD,attachment problems

Psychosis that has its own mnemonic tooso

many types and causes, with schizophreniasthe big family here Eating/elimination anorexia, bulemia,

enuresis, encopresis, etc.


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Why does Diagnosis Matter?

Maybe a specific treatment (truebipolar disorder, seizures, ADHD,OCD, depression)

Maybe acceptance (genetic, PANDAS)


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Screening overall Function(HEADS)

Home/ discipline

Education/ occupation

Activities/ friends

Drugs/ medications

Sex/ close relationships


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Assessment Ia:

History of the PresentCondition

Chief complaint Why now? History of present illness often

chronic

The who, what, where, when, how,and why of the problem

List of target symptoms


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Assessment Ib:

Developmental History

Pregnancy, labor & delivery illnesses, toxins,APGAR scores, length & weight, complications,

e.g., fetal distress, meconium staining, jaundice Infancy & early childhood early regulation,

attachment, and relationships; simple babygames

Milestones: e.g., walking, talking & toilettraining

Common childhood illnesses ear infections,strep, asthma


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Assessment Ic:

Individual Differences inRegulation and Processing

Sensory processing and integrationdisorders Motor tone, function and planning

disorders

Central auditory processing disorders;receptive and expressive languagedisorders

Visual-spatial processing disorders


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Assessment Id:

Social-Emotional Growth Regulation and calm attention

Capacity for warm engagement

Beginning circles of interaction Beginning themes and symbols

Complex symbols, communication, and

play Logical thinking, cause and effect in

social problem solving


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Assessment 1e:M r Hi t r

Family History medical, psychiatric anddevelopmental

Growth - height, weight, head circumference,level of physical/ sexual development

Medical review of systems hearing, vision,allergies, cardiac, neurologic, surgery &anesthesia, serious medical illness,hospitalizations

Psychiatric review of systems covering the

SOAPED areas, but also violence, aggression,suicidality, mistreatment, discipline, legalproblems, moves, etc.

Safety check: seatbelts & driving habits;


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Assessment II:TIME WITH THE PER N

Twice, minimally? Recommendations byprofessional organizations vs. realitiesof medical practice

The second time is almost alwaysdifferent, and gives the opportunity tocheck out ideas

See with family? Alone?

School visits? Home visits?

Video?


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Assessment III:

Collateral Information

People teachers, therapists,doctors, other caregivers, relatives,

job coaches, etc.

Records medical (labs, consults,growth charts, etc.); I.E.P.s andschool assessments; outside


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Variable presentation of

psychiatric conditions

Colored by developmental level

Colored by individual differences(cognition, language, sensoryprocessing tactile, auditory,visual/spatial - also visual motorintegration and motor planning, etc.)

Colored by quality of relationships


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Variable presentation ofpsychiatric conditions

example: Depression in EarlyChildhood with Intellectual

Developmental may be active or aggressive, appeardepressed

Individual differences might not have the words toexpress sadness, might instead be bothered more bysensory stimuli

Relationships might be helped a lot by a parent, butinconsolable at preschool, and acting out

Might present as a child who is biting and seems toneed sensory input, but after assessment you find a


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Differential Diagnosis and T r t m t m

Usually, going from chief complaint

to diagnosis is not easy, and the bestwe can do is come up with a list oftarget symptoms and a list ofpossible diagnoses


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Treatment:

Targets

Priorities


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GRIDDING OUT TARGET


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Priorities:

SAFETY 1st

Lynchpins

thorns

And maybe a few things that are justas well left alone.


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George Engel: Biopsychosocialmodel

Biological: exercise, diet, sleep,nutrition, medication

Psychological: all kinds of therapies,mind over illness

Social: family, school, etc.(WRAPAROUND concept)


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YOUR EXAMPLES HERE:


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Resources:

www.circlestretch.blogspot.com Professional groups: e.g. AACAP, Your

Childand Your Adolescent

Diagnosis support groups: e.g. ASA,TSA, CHADD, etc.

Looking for Kevin
http://www.circlestretch.blogspot.com/http://www.circlestretch.blogspot.com/

dual diagnosis - iep day powerpt (1 1)

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